'Chemo brain' catches many patients unaware; new program can help

Few patients are prepared for the cognitive side effects of cancer treatment, known as "chemo brain." A new City of Hope program is helping solve that problem.

The mental fog that patients can experience after undergoing chemotherapy treatment for cancer has a name: “chemo brain.”

“Many patients report hearing or reading about chemotherapy-related cognitive deficits, but few are actually prepared to deal with these changes,” said Celina Lemon, M.A., an occupational therapy doctoral resident in the Department of Rehabilitation Services.

With Lemon’s guidance and the support of the Department of Rehabilitation Services, occupational therapists at City of Hope implemented a program over the past year to help patients cope with the cognitive dysfunction that can occur during or after cancer treatment.

Nearly 200 patients have benefited so far.

The "chemo brain" program initially targeted those who must undergo an “autologous” stem cell transplant, which uses a patient’s own bone marrow. Before such a transplant, a patient’s immune system is typically suppressed by high-intensity chemotherapy, which has been known to contribute to cognitive decline. Since then, the program has expanded to any patient who qualifies for cognitive therapy after being assessed.

Keeping the mind sharp

Intervention focuses on improving the patient’s self-awareness, use of cognitive strategies during daily activities, and modifying their activities and environment. Compensatory strategies can include learning to use time-management tools, scheduling devices and smartphone applications that can provide helpful alerts in the course of daily routines.

During their acute-care stay, remedial activities aimed at cognitive stimulation and “brain games” help keep the patients’ minds engaged and active, according to Lemon.

“The compensatory strategies help alleviate the stress and frustration resulting from changes in short-term memory and attention loss that is commonly reported,” she said.

Through the program, patients also have the opportunity to discuss their current cognitive status and evaluate how their lives have been impacted by cognitive change.

“People often focus on their illness. They don’t really notice what is happening to their mental status. When we talk to them, it’s often the first time the patients open up about something outside of the cancer,” Lemon said. “The small adjustments they can make because of this self-awareness often make a world of difference once they return home.”

At the forefront of cognitive rehabilitation

With the goal of serving as a model for other institutions, the Department of Rehabilitation Services is documenting the success of the intervention. “We want to be at the forefront of cognitive rehabilitation,” Lemon said.

The majority of patients who underwent autologous transplants and received cognitive rehabilitation consider the program “helpful or essential,” according to data collected during three different points in their treatment.

They also reported it accomplished the program’s ultimate goal — improving the patient’s ability to independently carry out everyday tasks once they return home.